INTRODUCTION

This document provides an overview of the BC Mental Health Act relevant for families and others concerned about a person with mental illness.

The BC Mental Health Act exists to help someone with an apparent serious mental illness who refuses to obtain necessary treatment. Families should encourage their loved one to obtain treatment voluntarily. (There are other helpful documents and resources that may be helpful in encouraging voluntary treatment on http://www.bcss.org)

However, with some illnesses the person cannot be persuaded to accept treatment voluntarily. The only alternative is involuntary admission and treatment under the BC Mental Health Act. Families often play a crucial role in facilitating this.

The following issues are addressed:

  • Resources for using the BC Mental Health Act (MHA)
  • Purpose of the MHA
  • Involuntary Admission Criteria
  • Involuntary Admission Procedures
  • Providing information to assist
  • What happens at the Hospital Psychiatric Unit
  • Rights information to near relative relatives
  • Discharge from involuntary in-patient care
  • Extended leave
  • Rights and Review Panels
  • Confidentiality

 

MENTAL HEALTH ACT RESOURCES

Early on you should speak with someone knowledgeable about the MHA. Local BCSS Regional Educators will often be able to help or refer you appropriately. (Find one near you). Other resources include:

  • Regional Health Authorities, Mental Health and Addictions staff and websites or private psychiatrists.
  • Guide to the Mental Health Act, 2005 Edition, British Columbia Ministry of Health Note: this is the most helpful resource. It provides all Forms. Relevant page numbers are provided here. https://www.health.gov.bc.ca/library/publications/year/2005/MentalHealthGuide.pdf
  • Resources on this BCSS website (e.g., video of lawyer Gerrit Clements, A Guide for Spouses of Partners with Serious Mental Illness, Obtaining and Providing Mental Health Information: A Guide for Family Members.)

PURPOSE AND INVOLUNTARY ADMISSION CRITERIA

If a person cannot be admitted as a voluntary patient, the person can only be involuntarily admitted if a physician finds that the person meets all the following 4 criteria (section 22 MHA) listed on FORM 4 from the Guide to the Mental Health Act (2005).

1. Definition of Mental Disorder: “disorder of the mind that requires treatment and seriously impairs the person’s ability  (a) to react appropriately to the person’s environment, or (b) to  associate with others”) AND

2. Deterioration OR harm criterion: The person “requires care, supervision and control in or through a designated facility to prevent the person’s or patient’s substantial mental or physical deterioration or for the protection of the person or patient or the protection of others”  AND

3. Requires psychiatric treatment: requires [psychiatric] treatment in or through a designated facility” AND

4. Is not suitable as a voluntary patient.

Important Notes

  • The concept of “protection” in #2 above can refer to different types of harms, not just physical danger. Included are harms “that relate to the social, family, vocational or financial life of a patient.” (Justice Ian Donald, McCorkell verdict, Guide p. 9 )

 

TIPS TO GET A PERSON TO A PHYSICIAN TO BE EXAMINED FOR POSSIBLE INVOLUNTARY ADMISSION?

If a person is still unwilling to voluntarily be examined, there are three options for obtaining involuntary admission. We advise attempting them in the following order (if possible): Appeal directly to a physician; Request police assistance; Obtain an order from a judge or justice of the peace.

  1. Direct to a physician. You may be able to have a mental health team physician visit the ill person, or persuade the person to see a general practitioner, or take the ill person to an Emergency Department of a hospital (any hospital). This is the best way of proceeding—but if there is any concern about physical danger, the police have authority to intervene.
  2. Police assistance. (Guide p. 141) If there is an urgent situation or a likelihood of violence apparently as the result of mental illness, call 911 and ask for police assistance. Section 28(1) reads “A police officer or constable may apprehend and immediately take a person to a physician for examination if satisfied from personal observations, or information received [could include from family] that the person
         a) is acting in a manner likely to endanger that person’s own safety of the safety of others, and 
    b) is apparently a person with a mental disorder “ s. 28(1).The police officer may work with a crisis mental health team, but this is not necessary.  Police officers are trained to understand this as part of their duty to serve and protect. The ill person is usually escorted to the emergency room of any hospital for examination by a physician.
  3. Judge or Justice of the Peace. (Guide p. 114) When direct examination by a physician or police intervention is not possible, a provincial court judge can help—or a justice of the peace if a judge is not available. If there are reasonable grounds to believe that the physician criteria apply, anyone, including a family member, may use Form 9 to apply to a judge for an order to apprehend the ill person. If the judge agrees, a warrant is issued for the police to take the person to hospital for a physician examination.If a person is concerned about a “backlash” from the person with the illness Form 9 provides guidance to the judge. If the written application could “reasonably be expected to result in harm to your safety of mental or mental or physical health, you may ask the judge for permission to present your information verbally instead of completing this form, or for restrictions on the release of the information that forms the basis of this application.” We advise you to consult with someone who is knowledgeable about this process.

ASSISTANCE FROM RELATIVES—OBTAINING ADMISSION AND TREATMENT (Guide p. 66).

When admission to a psychiatric unit is being considered, families can provide important collateral information to the physician, police officer, or judge involved.

It helps to use the following headings to make notes of symptoms and behaviours as they happen:

a) Mental Disorder – Hallucinations, delusions, depression, irrational thoughts,

b) Prevention of substantial mental or physical deterioration – Previous episode(s) and now similar symptoms recurring or developing. (i.e. non-adherence to medication or treatments, not eating)

c) Need for protection of self or others – Threats,  paranoid delusions, deteriorating physical condition, irrational wasting of money, likelihood of losing job or family, suicidal thoughts or gestures.

d) Need for psychiatric treatment – Previous diagnosis and treatment. Current symptoms noted in (a) may also indicate a need for psychiatric re-assessment.

e) Unwillingness to accept voluntary treatment – You and/or others have tried to persuade the person to see a physician for examination and assessment but were unsuccessful.

Note: In a crisis situation, you may want to also seek advice or observations from a mental health clinic, family doctor, hospital psychiatric unit, police, urgent care teams, etc.

ON ADMISSION TO A PSYCHIATRIC UNIT

  • First physician’s certificate admits the patient for up to 48 hours
  • Second certificate holds the patient for up to 1 month (then certificates must be renewed)
  • Rights information is provided to the patient and near relative (1) (e.g., how to access the  Review Panel, how to obtain a lawyer, how to request a 2nd opinion on treatment, etc. (Rights Information, page 40-50)
  • Families can often provide the physician with important information about the efficacy of previous treatments, problems with side effects and other issues, plus the patient’s preferences.
  • Treatment is authorized by the patient if capable and in agreement with treatment, or by the Director if the patient is incapable.
  • If a family has a Representation Agreement including treatment preferences it can be considered but it does not apply to treatment under the MHA (see this website “The right to be well: BC guardianship legislation and the Mental Health Act.) That decision is made by the director of the psychiatric unit on the advice of treating physician.

 

PATIENT DISCHARGE AND EXTENDED LEAVE

Physician Discharge

A person who does not meet admission criteria must be discharged. However, discharging physicians must consider whether  “there is a significant risk that the patient, if discharged, will as a result of the mental disorder fail to follow the treatment plan…necessary to minimize the possibility that the patient will again be detained under section 22”. The person discharged from involuntary status can continue as a voluntary patient if the physician agrees.

Review Panel Discharge

A review panel uses the same criteria as a discharging physician.

Extended Leave (compulsory community treatment)

“Extended Leave” is available under the BC Mental Health Act and can help people adhere to their treatment plan in the community.

Section 37 of the Act states: “…if the director considers that leave would benefit a patient detained in a designated facility, the director may release the patient from the designated facility providing appropriate support exists in the community to meet the conditions of the leave.”

The patient must continue to meet admission criteria, with renewals examinations following the  same time periods as for inpatients. Responsibility for certificates can be delegated to community physicians who are part of a community mental health team.

If ‘Extended Leave’ conditions are broken, the patient returns to hospital.

Family’s role: Families can recommend to an authorizing physician that a patient be put on extended leave, especially if relapses recur due to not taking medication. Families can also provide information regarding the particular conditions of extended leave, and may participate in monitoring medication and compliance with other conditions (e.g., safe, stable residence, regular physician care, etc.)

 

REVIEW PANEL AND OTHER RIGHTS

If a patient wants to be discharged from hospital or from extended leave against their physician’s advice, the patient (or anyone else acting on the patient’s behalf) can appeal to a Review Panel. If the appeal is successful, the patient must be released.

A Review Panel includes a lawyer, a physician, and a person who is neither. All are independent of the hospital. Patients and their near relative are informed of their right to a Review Panel hearing on admission.

Family’s role. Detail on how families can be involved with a Review Panel hearing if they oppose the desire of the patient to be released can be found on the Review Board website at https://www.bcmhrb.ca/

       If a patient appeals to the Review Panel, the near relative (often a family member) is informed of the date of the hearing.  Family members who want to provide information in support of further detention of the patient must contact the attending physician. https://www.bcmhrb.ca/i-am-family-or-a-support-person-for-a-patient/

In addition to providing information relevant to involuntary admission, a family member may have important information for the Review Panel. Section. 25(2.1) of the Mental Health Act states: “A hearing by a review panel must include:

(a)  consideration of all reasonably available evidence concerning the patient’s history of mental disorder including (i) hospitalization for treatment, and (ii) compliance with treatment plans following hospitalization, and

(b) an assessment of whether there is a substantial risk that the discharged patient will as a result of the mental disorder fail to follow the treatment plan the director or a physician authorized by the director considers necessary to minimize the possibility that the patient will again be detained under section 22. [the admission criteria]”

Other Rights

The “near relative” receives notice of admission, review panel application, discharge, and rights. They may exercise rights on person’s behalf for the following:

  • Renewal certificate examinations
  • Second opinion on appropriateness of treatment plan (patient, or family request)
  • Review Panels or Courts for discharge

 

CONFIDENTIALITY 

Family members often have knowledge about the patient that would be helpful for clinicians responsible for admission, treatment plans, or discharge planning. Conversely, family members often need information from the medical team because the family is usually involved with supporting the person after discharge. If a patient consents to this information exchange, the clinician has authority to comply.

Sometimes a clinician will not provide information because the patient has not given specific consent. However, the Freedom of Information and Protection of Privacy Act allows for the following: “Public bodies [clinicians] may release necessary personal information to third parties without the consent of the client where disclosure is required for continuity of care or for compelling reasons if someone’s health or safety is at risk”  (See Guide to the Mental Health Act, page 119, and BC Schizophrenia Society policy paper, Obtaining and Providing Mental Health Information to Families. (1)

Family’s role. Some clinicians believe that “patient confidentiality” is absolute. They are unaware of important exceptions pertaining to the Freedom of Information and Protection of Privacy Act. Reference to Appendix 13 (p.119 of the Guide) can help physicians better understand these important legal exceptions. When everyone has the facts, essential information can flow both ways—allowing clinicians and families to work together to provide the best possible care and support for the patient.

 

(1) The MHA refers to a Near Relative who receives rights and other information. A patient can appoint anyone as a “near relative” including non-relatives. If no one is appointed by the patient, a person may be appointed by the physician from a list of relatives (see Guide, page 176). Thus it is possible that the closest relative (e.g. wife or husband) may not be appointed as the “near relative” by the patient even though that person is also the caregiver. The Guide points out that the physician may send notices to a family member, even though not appointed as a near relative.


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